Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Unit 1 Clin Med III > L2: GERD, esophageal disorders/cancer > Flashcards

L2: GERD, esophageal disorders/cancer Flashcards

1
Q

Red flags that require workup as they are not likely to be GERD

A 
Dysphagia→ may represent a complication, may be normal GERD
Hematemesis/GI bleeding
Weight loss, fever, fatigue
Anemia
*Inadequate response to tx*
Prior anti-reflux surgery
Personal history of cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GERD definition

A

Lower esophageal sphincter transiently relaxes→ backflow of stomach contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Montreal classification of GERD

A

reflux of stomach contents cause troublesome symptoms or complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of GERD

A 
Postprandial Heartburn (pyrosis)
Regurgitation
Bronchospasm
Laryngitis/hoarseness (consider laryngoscopy)
Chronic cough
Loss of dental enamel
Chest pain→ squeezing, substernal, radiate to back, neck, jaws, arms→ RULE out cardiac cause
Dysphagia→ rule out stricture
Water brash/hypersalivation
Globus sensation (lump in throat)
Odynophagea
Nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hallmark symptom of GERD

A

Postprandial Heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is GERD diagnosed?

A

CLINICALLY

Testing not usually needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Things that may aggravate GERD

A 
Obesity
Gravity→ elevate head of bed
Pregnancy
Tobacco/ETOH→ lower esophageal sphincter pressure
Foods
Meds that decrease LES pressure
Anticholinergics (Ditropan)
TCAs (Amitriptyline)
CCBs
Nitrates
Narcotics
Meds that injure mucosa: 
*Bisphosphanates* (fosamax, actonel)
Iron supplements
NSAIDs/ASA
Potassium
Tetracycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Amitriptyline

A

TCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ditropan

A

Anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fosamax, actonel

A

Bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Best diagnostic study to evaluate mucosal injury

A

EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Esophageal impedance testing

A

Shows complete vs incomplete bolus transit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Esophageal pH monitoring

A

Transnasal catheter vs wireless capsule option

Quantify reflux, pt logs symptoms. High sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Esophageal manometry

A

Measures function of LES and peristalsis, pressures and patterns of esophageal muscle contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 types of hiatal hernias

A
  1. Sliding hernia (most common)

2. Paraesophageal hernia (may require surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A hiatal hernia is when….

A

a portion of the stomach enters above the diaphragm into the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are hiatal hernias usually diagnosed?

A

Asymptomatic, usually incidental finding on a CXR:
retrocardiac mass +/- air fluid level
Without air fluid level, hard to diagnosis from CXR alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hiatal hernias have an increased risk of…

A

Mallory Weirss Tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hiatal hernias presentation

A

GERD: heartburn, cough, hoarseness, chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hiatal hernias treatment

A

Treat similarly to GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Lifestyles modifications to treat GERD

A 
Adjust bed to raise head
No food/drink within 3 hours of bedtime
Weight loss
Eliminate dietary triggers→ +/- chocolate, fried/fatty, caffeine, soda, alcohol, peppermint, citrus, onions, tomatoes
Eat smaller meals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mild/intermittent GERD tx approach

A

Step up therapy
Less than 1-2 episodes/week + no evidence of erosive esophagitis
Tx: lifestyle modifications, H2RAs +/- Antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Severe GERD tx approach

A

Step down therapy
Frequent, >1-2 episodes/week, impair quality of life
Tx: PPI daily x 8 weeks + lifestyle modifications → gradually decrease therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Antacids (TUMS)

A

Neutralize gastric pH, short lived benefit, do not prevent GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Ranitidine
H2 blocker
26
H2 blockers MOA
Block action of histamine at H2 receptors of gastric parietal cells→ decreased secretion of acid
27
1st line medication for GERD
H2 blockers low dose PRN
28
If a patient is taking the maximum dose, BID, of a H2 blocker and is still refractory...
Switch to PPIs
29
Omeprazole (Prilosec)
Proton Pump Inhibitor
30
Lansoprazole (Prevacid)
Proton Pump Inhibitor
31
Esomeprazole (Nexium)
Proton Pump Inhibitor
32
Pantoprazole (Protonix)
Proton Pump Inhibitor
33
PPIs MOA
Reduce amount of acid produced by glands in the stomach | Take 30 minutes before the 1st meal of the day
34
How to dose a PPI
Without barrett's take the lowest dose for the shortest possible duration discontinue in patients without symptoms
35
If a low dose PPI is not effective
increase from once daily to BID follow up or schedule endoscopy If warning signs, endoscopy indicated
36
PPI dosing for Barrett's esophagus
longer term use | maintenance acid suppression to avoid recurrence of symptoms
37
PPIs adverse effects
``` Risk of infection Decreased acid→ decreased protection against bacteria→ C. Diff, other infections Malabsorption *Magnesium*, +/- Calcium, B12, Iron Other risks → dementia, heart disease? ```
38
Monitor _______ while on PPIs
Check Mg periodically +/- yearly B12, bone density
39
Indications for anti-reflux surgery
Failed optimal medical management GERD complications→ esophagitis, Barrett’s Noncompliance
40
Nissen Fundoplication
Preferred anti-reflux surgery laparoscopic or open Passage of gastric fundus behind to esophagus→ encircle distal esophagus
41
Esophagitis definition
Gastric acid + pepsin + bile → irritation of the squamous epithelium→ inflammation, irritation, erosion, ulceration
42
Types of esophagitis
``` Reflux (most common) Infectious Pill Eosinophilic Radiation ```
43
Esophagitis presentation
Similar to GERD→ heartburn, regurgitation, cough, chest pain
44
Complications of esophagitis
Bleeding Stricture Barrett’s Esophagus
45
Barrett's esophagus
Recurrent acid injury→ squamous epithelium in distal esophagus replaced with columnar epithelium
46
Barrett's: _____ epithelium in _____ esophagus are replaced with _____ epithelium
squamous distal columnar
47
Progression of Barrett's esophagus
GERD→ Barrett’s Esophagus→ low grade dysplasia→ high grade dysplasia→ Adenocarcinoma
48
Who get Barrett's esophagus
M>F, 55 years | Found in 10-15% of patients undergoing EGD for GERD
49
Treatment of Barrett's esophagus
PPI→ indefinite use EGD surveillance→ detect evidence of dysplasia Removal
50
2 ways to remove cells of Barrett's esophagus
Endoscopic Eradication Therapy (EET)/Endoscopic Ablation (EA) Thermal or photochemical energy to destroy Barrett mucosa ``` Endoscopic Resection (ER) Remove segment of Barrett mucosa→ therapeutic and quantifies depth of involvement ```
51
2 types of esophageal cancer
Squamous cell carcinoma | Adenocarcinoma
52
Squamous cell carcinoma vs Adenocarcinoma: Epidemiology
Squamous cell carcinoma: urban areas, african american men Adenocarcinoma: caucasians, M>F
53
Squamous cell carcinoma vs Adenocarcinoma: incidence
Squamous cell carcinoma: decreasing Adenocarcinoma: increasing, focus on early detection and prevention
54
Squamous cell carcinoma vs Adenocarcinoma: risk factors
Squamous cell carcinoma: smoking, alcohol, diet low in fruits/vegetables, selenium/zinc deficiency, caustic esophageal injury, +/- HPV Adenocarcinoma: *Barrett’s* → .5%/ year (1/200) progress Smoking, obesity
55
Presentation of esophageal cancer
Progressive dysphagia: solid food→ soft foods→ liquids Weight loss, odynophagia, malnutrition, anorexia
56
Esophageal cancer prognosis
50-80% of patients present with incurable, unresectable, or metastatic disease→ palliative treatment: +/- Chemo, radiation, surgery
57
If a patient has dysphagia...
perform endoscopy! | +/- Barium contrast esophagram
58
Infectious Esophagitis
Immunocompromised, inhaled steroids, recent abx use→ Candida
59
Tuberculosis Infectious Esophagitis
Night sweats, cough, (+) PPD
60
Pill Esophagitis
Medication induced, ibuprofen “gets stuck”
61
Esophagitis Associated with Systemic Illness
Systemic Sclerosis (collagen vascular disease) → poor acid clearing→ Epithelial damage
62
Eosinophilic esophagitis definition
Asthma, rhinitis, food allergies, chronic eczema (atopic dermatitis)→ Chronic, immune/antigen-mediated, eosinophil predominant inflammation Incidence increasing, M>F
63
Eosinophilic esophagitis symptoms
``` Dysphagia food impaction chest pain refractory heartburn/GERD upper abdominal pain ```
64
Eosinophilic esophagitis diagnosis
clinical history + EGD→ stacked circular rings, stricture
65
Eosinophilic esophagitis treatment
Diet→ avoid allergens PPI Topical corticosteroids→ ICS spray + swallow (don’t inhale) +/- esophageal dilation
66
Stacked circular rings and stricture on EGD
Eosinophilic esophagitis
67
Symptoms of esophageal motility disorders
Dysphagia non-cardiac chest pain refractory GERD
68
How to diagnose esophageal motility disorders
Must first perform EGD→ rule out structural abnormality Manometry barium swallow esophageal pH impedance monitoring
69
Hypercontractile/Jackhammer Esophagus presentation
angina that occurs with meals
70
Hypercontractile/Jackhammer Esophagus on manaomatry
high pressure (high amplitude) contraction in the esophagus with normal relaxation of the esophagogastric junction
71
Hypercontractile/Jackhammer Esophagus treatment
CCB (diltiazem) or TCA (imipramine) | +/- botulinum toxin injection
72
Diltiazem
CCB
73
Imipramine
TCA
74
Achalasia definition
progressive degeneration of esophageal neurons→ failure of relaxation of lower esophageal sphincter and lack of peristalsis
75
Achalasia presentation
``` gradual onset, rare dysphagia regurgitation difficulty belching chest pain heartburn ```
76
In which patients should you consider Achalasia?
a patient who is unresponsive to PPIs after 4 weeks with dysphagia to solids and liquids with regurgitation
77
Diagnosis of Achalasia
EGD→ *required to rule out malignancy* Manometry→ *Required for diagnosis* Barium esophagram
78
Achalasia on manomety
Aperistalsis (no contraction) in distal 2/3rds of esophagus and incomplete lower esophageal sphincter relaxation *Required for diagnosis*
79
Achalasia on barium esophagram
Esophageal dilation *Birds Beak* sign Aperistalsis Poor emptying of barium
80
Treatment of achalasia in a low surgical risk patient
Myotomy or Pneumatic Dilation | If it fails, repeat or try the other
81
Treatment of achalasia in a high surgical risk patient
1st line Botulinum toxin | 2nd line Nitrates, CCBs
82
Heller myotomy
incision that disrupts lower esophageal muscle fibers to treat achalasia
83
Pneumatic dilation
disrupts lower esophageal muscle fibers to treat achalasia | Sized 3 cm to 4 cm
84
Biochemical reductions in Lower Esophageal Pressure (3)
Botulinum toxin Nitrates CCB
85
mucosal laceration in distal esophagus and proximal stomach
Mallory Weiss tear
86
Mallory Weiss tear presentation
repetitive vomiting and retching, hematemesis
87
Predisposing factors of a Mallory Weiss tear
``` excessive ETOH intake hiatal hernia (increased abdominal pressure) ```
88
Mallory Weiss tear diagnosis
Endoscopy | If already resolved, clinical diagnosis
89
Mallory Weiss tear treatment
Stabilize patient Control bleeding→ epinephrine or electrocoagulation PPI Address predisposing factors

Unit 1 Clin Med III (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions